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1306 MAY 12, 1962 HUNTINGTON'S CHOREA BmSNH MEDICAL JOURNAL and these patients tend to be more excitable than normal. The pedigrees of seven affected families have for the Br Med J: first published as 10.1136/bmj.1.5288.1306 on 12 May 1962. Downloaded from They may be made worse by the excitement of attending first time been disentangled and are presented with some a clinic or being admitted to a ward, while some are suggested links between them. made worse even by a visit from a friend. From Some psychiatric aspects records it is are discussed and mention hospital apparent that many patients have is made of the clinical features employed locally for deteriorated on arrival in a ward and gradually early diagnosis. improved spontaneously over two to three days. Neglected nutrition and personal tidiness are often For the great interest and encouragement shown in this found in affected patients, who will improve greatly work I thanik Dr. J. Ronald. Both he and Dr. Martin after these are corrected in hospital or when the patient Whittet have kindly made all their hospital records available. is induced to live with relatives. Incidental febrile illness Without the very willing help of the physicians, psychiatrists, local practitioners, and the district registrars, this survey such as influenza has often been found to accentuate could the choreic symptoms in our patients. The influence never have been completed. of alcohol and the improvement following abstinence has frequently been demonstrated in this series. REFERENCES Religious tendencies were noted in some patients but Bell, J. (1934). Huntington's Chorea, in Treasury of Human Inheritance, edited by R. A. Fisher, vol. 4, pt. 1. Cambridge assumed serious proportions only in the cases of Univ. Press. K, IV 32 and N, III 27. Superstition and religion are Bickford, J. A. R., and Ellison, R. M. (1953). J. ment. Sci., 99, commonly intertwined with the life of any fishing 291. Brain, W. R. (1952). Diseases of the Nervous System, 4th ed. community and are well in evidence here. Oxford Univ. Press. Features of persecution, aggression, and grandiose Clarke, J. M. (1897). Brain, 20, 22. behaviour are occasionally found in the hospital Critchley, M. (1934). J. State Med., 42, 575. Davenport, C. B. (1916). Eugenics Record Office Bulletin, No. 17, records. p. 981. " That form of insanity which leads to suicide " is Elder, G. (1899). Scot. med. surg. J., 4, 410. part of Dr. George Huntington's original description of McWilliam, W. (1937). Caledon. med. J., 16, 31. the disease. Bickford and Ellison (1953) have observed Pleydell, M. J. (1954). Brit. med. J., 2, 1121. a high incidence of suicide in their series in Cornwall West, S. (1887). Quoted by S. Mackenzie, Brit. med. J., 1887, 1, and give this as a reason for some of their cases receiving 435. awards for gallantry during the war. The fishermen of North-East Scotland have long had a reputation for skill, endurance, and courage. This is probably a feature of the breed, whether affected or not, and as the patients here reviewed have a complete lack of insight it is NON-HEREDITARY CHRONIC ADULT unlikely that self-destruction need be feared here. CHOREA AS A CLINICAL ENTITY Suicide has been suggested for only one patient (L, III 5), BY but of course cannot be verified. http://www.bmj.com/ Sexual forms of mental disturbance have been RAE LL. LYON, M.D., M.R.C.P.Ed. observed by American writers, who claim that it is Senior Medical Registrar, Raigmore Hospital and Royal commonly part of Huntington's chorea. This tendency Northern Infirmary, Invernzess does not occupy a prominent place in the accounts in this country and was encountered only once (P, IV 8) When Dr. George in this series. Huntington (1872) first described the form of chronic adult chorea which now bears his name Neurology.-Accurate information about the neuro- he emphasized " its hereditary nature," stating that " it logical changes is available for a very few of the cases is confined to certain and fortunately a few families, on 26 September 2021 by guest. Protected copyright. in this series. The majority appear to have presented and has been transmitted to them, an heirloom from the typical picture, and the spread of the disease has generations away back in the dim past." followed the usual pattern, with individual variation The appearance of Huntington's chorea in covering a wide range. One case (K, IV 26) showed an patients whose parents increase in muscle tone suggesting an extension of the have been free from the disease has long been the subject of debate, and family disease process to neighbouring areas. The involvement circumstances are of the respiratory muscles by chorea is reported by seldom clear enough to be acceptable as proof. In the Moray Firth area we find a sufficiently Julia Bell (1934) as a great rarity. An example of this regular pattern of complication has been noted in R, III 2. spread to permit conclusions being drawn from the breeding habits of patients' ancestors in assessing Summary the likelihood of hereditary disorders. During a recent survey of the disease in this area it Huntingtons chorea appears to have been first has been shown that all the choreic Firth area in 1893. patients can trace recognized in the Moray the family origin to a small fishing village in Ross-shire. The disease is not found in the families of Highland These fishermen appear to have settled here about 300 stock, and some of the reasons for this are given. The years ago and to have kept themselves quite apart, affected patients can all claim their origins from one marrying within their own community or occasionally small fishing village in Ross-shire which was probably bringing brides from other ports. In contrast to this settled about 300 years ago. The place whence those nest of Huntington's chorea, two patients were peoples came is uncertain. discovered who appear to resemble true cases of The earliest case of Huntington's chorea diagnosed Huntington's chorea so closely that they were in fact by implication is S, II 1, who was probably born about given this diagnosis, but on scrutiny they lack the 1.810. necessary hereditary background. HUNTINGTON'S MAY 12, 1962 CHOREACHORBA MEDICALBRrITSHJOURNAL 1307 The moved Family A patient about, taking housekeeper's jobs, and Br Med J: first published as 10.1136/bmj.1.5288.1306 on 12 May 1962. Downloaded from This clan's name is mainly associated with Inverness- it is perhaps significant that she was on the point of shire. A small branch has for many years been settled becoming engaged to be married but had to return home in Sutherland, and this family can be described as urgently to nurse (for 12 years) her mother, who had small farmers who lived and worked about five miles from suffered a shock. There- Bonar Bridge. after the patient looked after FAMILY B her father, who was a " fine A, I 4.-No details of this man's parents could be verified old man" and who died at though he is known to be of Highland stock. He died of the age of 84. tuberculosis about the age of 40, four years after his wife (A, I 5), who had the same complaint and is also considered For the next few years she to be a Highlander. continued housekeeping and E O is described as being " old- A, lS5.-This woman was born in 1900, was brought up maidish" and given to by a maternal grandmother, and married a farm servant in affectations. 1922. About 1945 she found a nervousness starting, particularly when she was excited. Three years later a At the beginning of "fidgeting" of the right hand began and has slowly October, 1943 (aged 47), she progressed to involve all the limbs. Hospital assessment became nervous and excit- was undertaken in 1950. She was noted to be emotional able, with frequent grimacing iv and to have constant coarse jerking movements of the arms, and wild claims that she was face, and head. The right leg was spastic. In the ensuing going to be married. She years the family moved several times and regular medical had delusions of supposed b supervision was lost until traced for the present review. associations with the man. Both her person and the house showed signs of moderate As the excitement and confusion became worse she was neglect. The chorea was more obvious in the arms than in admitted to hospital with the diagnosis of an acute con- the legs. Her head often jerked and the tongue and mouth fusional state. Physical examination showed a fine tremor muscles were also involved. The limbs showed a slight and erratic co-ordination. In hospital she became gradually increase in tone; reflexes were slightly increased but the calmer, but about two months later jerking choreiform move- plantars were flexor. Electroencephalograms did not suggest ments were observed. A diagnosis of Huntington's chorea cortical degeneration. The patient has become a little was made. Discussion FAMILY A It has already been shown that Huntington's chorea is not uncommon in the Moray Firth area but that it is confined to those connected with a fishing community. The ancestry of the two patients described here has been traced back about 100 years without finding any relatives with chorea. There has been no association II with the fishing families, and any connexion is most unlikely in earlier times because of the almost com- plete lack of mixing among the fisher folk, the clansmen, http://www.bmj.com/ ,II or the farm servants.

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